Evaluation of the malaria diagnosis program in the national public laboratory network, Colombia, 1997-1999

Abstract

In 1995, the Parasitology Group-National Reference Laboratory- at the Instituto Nacional de Salud (INS) started a national malaria diagnosis program with the Public Health Laboratory Network which included training, indirect quality control, external quality control, technical assistance, advisory, reference and counterreference, together with an annual review of the program. The purpose of this study was to carry out a three year (1997-1999) analysis of the program. In the indirect quality control program, average positive and negative concordances of 98% and 97%, respectively, and a kappa index of 0.95 were obtained by the state public health laboratories. In the external quality control program, an average concordance of 74.2% was obtained with an 89.2% participation of the registered laboratories. At the municipal level, the indirect quality control had an average concordance of 91.4% in positivity, 92.5% concordance in negativity, and a kappa index of 0.84. On the other hand, indirect quality control has been scarcely implemented by the state public health laboratories in the municipalities under their jurisdiction. In general, the program shows a good performance, despite some economic and conflict-related difficulties in the country, because people responsible at all levels for the Malaria Program have permanently carried out all other activities of the network, either according to annual programming or upon request. However, it is important to improve its coverage and the participation in its activities.